Introduction:The BD Helping Build Healthy Communities (HBHC) program is a philanthropically funded initiative designed to provide support for comprehensive medication management (CMM) services at Federally Qualified Health Centers (FQHCs) to support care for low-income populations.Objectives: The primary outcome of interest was the change in glycosylated hemoglobin (HbA1c) between baseline and 6 months with changes in systolic (SBP) and diastolic blood pressure (DBP) between baseline and 6 months being evaluated as secondary outcomes.Methods: Awardees of the HBHC program who provided clinical pharmacist led CMM services in 2017, 2018, or 2019 to address the needs of people living with diabetes, were asked to complete a standardized monitoring template to evaluate their progress in serving patients receiving care at their clinic. The data from these reports was then analyzed using the paired t test to identify statistically significant changes in HbA1c, SBP, and DBP.Results: A total of eight FQHCs, providing care to a total of 2502 patients, received funding within the HBHC program for their CMM activities related to diabetes.Within the primary outcome analysis of the change in HbA1c at 6 months, a statistically significant reduction in average clinic HbA1c between baseline and 6 months (9.4 vs 8.2, mean difference 1.2, 95% CI [0.45-1.97, P <.01]) was observed. Similarly, a statistically significant reduction was observed between baseline and 6 months for
Introduction Diabetes and depression may present concurrently, and clinical pharmacists are well equipped to manage these conditions. Clinical pharmacists were grant funded to implement a diabetes-focused randomized controlled trial in a Federally Qualified Health Center. The objective of this analysis is to evaluate if glycemic control and depressive symptoms improve for patients with diabetes and depression with additional management from clinical pharmacists compared with those receiving the standard of care. Methods This is a post hoc subgroup analysis of a diabetes-focused randomized controlled trial. Pharmacists enrolled patients with type 2 diabetes mellitus (T2DM) and a glycated hemoglobin (A1C) greater than 8% and randomly assigned them to 1 of 2 cohorts, one managed by the primary care provider alone and one with additional care from the pharmacist. Pharmacists completed encounters with patients who have T2DM with or without depression to comprehensively optimize pharmacotherapy while tracking glycemic and depressive outcomes throughout the study. Results A1C improved from baseline to 6 months in patients with depressive symptoms who received additional care from pharmacists by −2.4 percentage points (SD, 2.41) compared with a −0.1 percentage point (SD, 1.78) reduction in the control arm (P .0081), and there was no change in depressive symptoms. Discussion Patients with T2DM and depressive symptoms experienced better diabetes outcomes with additional pharmacist management compared with a similar cohort of patients with depressive symptoms, managed independently by primary care providers. These patients with diabetes and comorbid depression received a higher level of engagement and care from the pharmacists, which led to more therapeutic interventions.
IntroductionDue to the current coronavirus disease 2019 (COVID‐19) pandemic, telehealth has shifted from an underutilized service to a medical necessity almost overnight. While guidelines are available regarding implementation of telepharmacy services, there is limited practice‐level evidence demonstrating successful adoption of telepharmacy for the delivery of clinical pharmacy services.ObjectivesThe purpose of this article is to provide a description of how telehealth has been utilized to deliver pharmacy services within a Community Health Center (CHC), to discuss the impact of telehealth services, and to provide a framework by which other entities may create successful telehealth programs within the ambulatory care setting.MethodsOverall CHC productivity, clinical pharmacist productivity, and patient demographics were compared between the 7 months preceding and the 7 months after implementation of telehealth services. Patient satisfaction with telehealth was measured via anonymous surveys administered via Feedtrail XM and provider satisfaction was measured via a survey created by the New Jersey Primary Care Association.ResultsTelepharmacy has caused a shift in the demographics of patients receiving pharmacy services, increasing the proportion of patients with private insurance, who were 65 years or older, and who were non‐English speakers. While overall productivity at the CHC remained stable, the number of clinical pharmacy encounters increased. Patients were satisfied with telepharmacy visits indicating that they were of the same or greater quality than in‐person visits and expressed a preference to continue telepharmacy visits in the future.CONCLUSIONSOur results suggest that telepharmacy is an effective way to deliver care particularly around chronic conditions. To be sustainable, telehealth requires ongoing support from local, State, and Federal agencies in terms of maintaining regulations around expanded scopes of practice and in terms of reimbursement.
Objectives: Discrete choice experiments (DCEs) are used in outcomes research to elicit stated preferences and characterize decision-making processes. A DCE presents participants with scenarios describing the research object as a combination of levels of relevant attributes. Multiple-scenario DCEs (MS-DCE), present two or more scenarios side by side and ask for a choice between the scenarios, while single-scenario DCEs (SS-DCE) present one scenario at a time and require a choice for each scenario. This study aimed to explore the use of SS-DCEs in healthcare research. MethOds: A systematic literature search, combining terms for DCEs with broad healthcare terms, was conducted in Medline, Embase and PsycInfo (no date restriction). Publications were independently reviewed by two reviewers. Eligible studies presented discrete choices based on single scenarios constructed with varying levels of attributes, and addressed a healthcare topic. Information on rationale and study design were extracted from all included studies. Results: Our search identified 3308 studies, of which 29 presented 26 different SS-DCEs eligible for inclusion, and 697 presented MS-DCEs. Thirteen of the 26 SS-DCEs were published between 2011 and 2015. The most common topics were treatment or diagnostic interventions (n= 15), and healthcare settings and programs (n= 4). Decisions were made on behalf of a third party (e.g. physician for a hypothetical patient, or adult caregiver for a child) in 14 of the 26 studies. Three studies indicated using a SS-DCE rather than a MS-DCE design as it more accurately represented the decision situation being investigated, e.g. a physician seeing one patient at a time. cOnclusiOns: We have provided a comprehensive synthesis of studies employing the less familiar SS-DCE design. This synthesis will be valuable for researchers considering employing an SS-DCE and for developing methodological guidance for future research using SS-DCEs. Further work is needed to explore the economic theory underpinning the SS-DCE design.
Introduction There is growing interest in pharmacist‐led chronic disease management (CDM) for underserved populations such as those treated within Federally Qualified Health Centers (FQHCs). Objectives To assess the impact of adding a pharmacist to the healthcare team within an FQHC for CDM. Methods This is a non‐randomized, 6‐month prospective pilot study whereby any member of the healthcare team could refer a patient to receive CDM from a pharmacist. The primary outcome is change in disease control as measured by primary clinical endpoint. Primary clinical endpoints for the most common disease states include glycated hemoglobin (A1C) for type 2 diabetes mellitus (T2DM), systolic blood pressure (SBP) for hypertension, Generalized Anxiety Disorder‐7 (GAD‐7) score for anxiety, and Patient Health Questionnaire‐9 (PHQ‐9) score for depression. Primary clinical endpoints are compared using a paired t test for the modified intention‐to‐treat population. Secondary outcomes include change in self‐reported health and healthcare utilization and difference in satisfaction with care between the primary care provider (PCP) and pharmacist. Results Three hundred patients were enrolled of whom 199 were included. Most patients were referred by their PCP. Statistically significant differences in the mean primary endpoint were observed for all disease states with at least 20 participants, including T2DM (n = 96, change in A1C ‐2.1%, P < 0.001), hypertension (n = 32, change in SBP ‐29.7 mmHg, P < 0.001), anxiety (n = 25, change in GAD‐7 score − 7, P < 0.001), and depression (n = 22, change in PHQ‐9 score −11.1, P < 0.0001). While statistically significant changes in self‐reported healthcare and healthcare utilization were not observed, patients were more satisfied with care. Conclusion When provided with prescriptive authority and working within an interdisciplinary primary care team, pharmacists were able to impact clinical and humanistic outcomes in the FQHC, leading to improved CDM for a variety of illnesses. More studies should be conducted to validate these results in other settings.
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